Irena Papadopoulos Professor of Transcultural Health and Nursing Middlesex University
Culturally Competent and Safe Organisations CCS teams CCS individuals CCS patient care
The need for culturally safe healthcare teams The challenges related to developing culturally safe teams The characteristics of culturally safe teams The implications of culturally unsafe teams
An Organisation with Memory (DoH 2000) Every year... 400 people die or are seriously injured in adverse events Nearly 10,000 people are reported to have experienced serious adverse reactions to drugs Around 1,150 people who have been in recent contact with mental health services commit suicide Nearly 28,000 written complaints The NHS pays out around 400 million a year to settle negligence claims
There is a long history of international doctors working in the NHS and also of recruitment of nurses from overseas. In 2002 2003 more than half of the nurses newly registered with the Nursing and Midwifery Council (NMC) had trained outside the UK. EU legislation and policy promotes mobility of people and some EU countries have seen an increase of health staff from the EU (mainly from East to N. West) (www.ieneproject.eu/) Thus, the globalisation of healthcare has meant that multiprofessional healthcare teams are now also likely to be multicultural healthcare teams, with the potential for further barriers to effective healthcare practice.
Many non UK qualified doctors find a distinct difference in the ethical framework of practice in the UK e.g: emphasis on individual autonomy and patients rights, confidentiality and informed consent, Shared decision making model Many non UK qualifiers identified concerns about communication on entering practice in the UK (language, dialects etc) Also concerns about lack of knowledge regarding social, cultural and behavioural norms of host country Recognition of the ethical, legal and cultural context of the UK health care does not happen until doctors are in practice Need for training.
Smith et al (c2007) report that overseastrained nurses are over-represented in cases of clinical malpractice reported to the Nursing and Midwifery Council (NMC), and argue that this is related to insufficient diversity awareness [of the host country]...
The importance of inter-professional practice in health and social care is now recognised. Barriers to successful inter-professional practice have been identified: different professional cultures resulting from education and training communication difficulties between the various professional groups relating to traditional hierarchies
Individual values, attitudes, perceptions and patterns of behaviour may be different among individual members of multi-disciplinary multicultural teams Must acknowledge that managing the cultural diversity that exists in health care poses many challenges
Patients of minority cultural and language backgrounds are disproportionately at risk of experiencing preventable adverse events while in hospital compared with mainstream patient groups, Contributing factor is the failure of patient safety programmes to recognise the critical relationship that exists between culture, language and safety and quality of care. Culture is an influencing factor in shaping people s perceptions and experiences of health and health care, whether they are the providers or recipients of care. They stress that Patient safety policy... must contain explicit and substantive mention of the complexities and implications of the mediating variables of culture and language in the clinical encounter (p387). Johnstone M and Kanitsaki O (2006) Culture, language, and patient safety: making the link. Int. J. Quality in Health Care, 18 (5):383-388
He suggests five fundamental dimensions to national culture. These can be summarised as: 1. Hierarchy Hofstede calls this dimension power distance ; it relates to the extent to which individuals within a culture accept unequal distribution of power. At one end of this continuum are cultures that value hierarchy. In these cultures, the emphasis is placed on leader status; individuals will expect the team leader to provide direction and make decisions. Individuals within these cultures tend to be accepting of rules and questioning authority may be discouraged. At the other end of the continuum are cultures that place a lot of emphasis on team involvement, with wide consultation and group decision-making being common. Questioning authority is likely to be accepted or even encouraged in these cultures.
2. Ambiguity - This dimension, labeled by Hofstede as Uncertainty Avoidance deals with the degree to which individuals feel comfortable with ambiguity. At one end of the continuum are cultures that encourage risk taking; in these cultures individuals are likely to feel very comfortable trying new and different ways of approaching things. At the other end of the continuum are cultures that place more value on routine, regulation and formality. Individuals in these cultures are likely to prefer tried and tested ways of doing things rather than taking risks with unknown methodologies. 3. Individualism / Collectivism - This dimension relates to the extent to which the individual values self-determination. In an individualistic culture people will place a lot of value on individual success and the need to look after oneself. At the other end of the dimension are collectivist cultures in which individuals will place more value on group loyalty and serving the interests of the group.
4. Achievement-orientation One end of this dimension is masculine and the other end is feminine. A culture at the masculine end of the continuum will be very achievementoriented, valuing things such as success, achievement and money. At the other end of the continuum are cultures that place more value on aspects such as quality of life, interpersonal harmony and sharing. 5. Long-term orientation This dimension was a later addition to Hofstede s work. At one end of the continuum are cultures that focus on long-term rewards; at the other end are cultures that are more concerned with immediate gain.
Seven Steps to Patient Safety NHS National Patient Safety Agency
Let us build healthcare worlds which prepare and support healthcare team members to be culturally competent in order to provide safe care and compassionate care. Let us all try and build the healthcare service with a diverse world in mind.